- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $5,337.52
| Facility | | $100.00 | $2,331.21 | $5,337.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $20,162.41 / $35,151.03
| Facility | | $8,512.20 | $20,162.41 | $35,151.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,784.89 / $5,257.46 / $5,441.47
| Facility | | $1,784.89 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.02 / $177.02 / $177.02
| Facility | AS | $177.02 | $177.02 | $177.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,629.00 / $12,629.00 / $12,629.00
| Facility | | $12,629.00 | $12,629.00 | $12,629.00 |